Immunogenicity and Safety of Two Doses of a Paediatric Hepatitis A Vaccine in Thai Children: Comparison of Three Vaccination Schedules (original) (raw)
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Hepatitis A virus vaccination strategy and pre-immunization screening of Bangladeshi children
Background: HAV infection is endemic in many developing countries like India, Pakistan, Nepal etc. Several seroprevalence studies show high rates of sero-positivity among children by sub-clinical infection. Therefore mass vaccination against HAV has not been recommended in endemic countries. Objective: To determine whether routine hepatitis A vaccination is indicated for all Bangladeshi children & also to know whether pre-vaccination screening is necessary. Materials & Methods: Serum samples from 254 children aged between 1-15 years were tested for antibody (IgM & IgG) against hepatitis A virus (HAV) to determine the seroprevalence of HAV antibody and do a cost-benefit analysis for decision making about vaccination against HAV among the children of Bangladesh. Results: Hepatitis A virus antibody was positive in 141 (55.5%) of 254 children. Age-specific sero-prevalence was 13 (23.2%) of 56 in 1-3 year,64 (55.2%) of 116 in 3-5 year, 39 (70.9%) of 55 in 5-10 year & 25 (92.6%) of 27 in 10-15 year age group. Cost benefit analysis showed that the total cost of screening followed by vaccination was almost 1.8 times less than the total cost of vaccination of all children without screening. Conclusions: Majority of the children were found sero-positive against HAV around 15 year of age. Therefore mass vaccination against HAV may not be required for Bangladeshi children.
Scientific Reports
This cross-sectional study aimed to assess seroprevalence of hepatitis A virus (HAV) antibodies and identify factors associated with HAV seropositivity among children and adolescents aged 1–18 years who resided in Chiang Mai, Thailand. Sociodemographic characteristics, sanitation/hygiene, and history of HAV vaccination were collected. Anti-HAV IgG antibody was determined, and a level ≥ 1.0 S/CO defined HAV seropositivity. We enrolled 300 participants; median age 8.7 years, 54% male, and 13% overweight (BMI z-score: + 1 to + 2 standard deviation [SD]). Sixty-five participants (22%) were vaccinated against HAV. Overall, 84/300 participants (28%) demonstrated HAV seropositivity, of whom 55/65 (85%) and 29/235 (12%) were among vaccinated and unvaccinated participants (P < 0.001), respectively. Previous HAV vaccination (adjusted odds ratio [aOR] 47.2; 95% CI 20.0–111.8) and overweight (aOR 4.4; 95% CI 1.7–11.3, compared with normal weight [BMI z-score: − 2 to + 1 SD]) were significant...
Epidemiology and Outcome of Severe Hepatitis A Infection in Children in Kuwait
Medical Principles and Practice, 2006
days. The rate of complications of HAV infection was 6% and only one child required admission to the intensive care unit for fulminant hepatitis. None of the patients had permanent sequelae. Conclusions: HAV infection is a signifi cant cause of morbidity for children in Kuwait. The disease is mostly prevalent in preschool and school age children. Despite the excellent outcome of all patients, a considerable number of patients tend to have a complicated course and prolonged hospitalization. In view of these data, hepatitis A vaccine should be considered as a part of routine childhood immunization in Kuwait.
Medical Journal Armed Forces India, 2019
Background: Hepatitis A virus (HAV) causes an enterically transmitted viral disease mainly affecting children and endemic in many developing countries, including India. There is an epidemiological shift with an increased incidence of symptomatic cases among children. This study was conducted to assess the seroprevalence of HAV among young children aged below 5 years and the need for universal immunization. Method: This cross-sectional study was conducted at two tertiary care hospitals in Northern India, from Apr 2014 to Jul 2015, among healthy children aged between 1 and 5 years. The sample size was calculated based on the prevalence of HAV seropositivity of 40% among children aged <10 years [16e60%] and alpha error of 5%. Analysis of serum IgG against HAV was performed by enzyme-linked immunosorbent assay method, and results were analyzed. Results: A total of 1084 children aged between 12 and 60 months were enrolled, with maleto-female ratio of 1.86:1. A total of 471 children (43.5%) were found to be positive for IgG against HAV. The seroprevalence of HAV was lower among younger children aged 12e23 months (odds ratio [OR] ¼ 0.73, 95% confidence interval [CI] ¼ 0.52e0.87, p ¼ 0.03), which was statistically significant. Seropositivity of HAV was lower among boys and families consuming safe drinking water and having improved sanitation facilities. Conclusion: The study observed lower seropositivity against HAV among younger children, making them susceptible of contracting the disease. Possible underlying risk factors were younger age, unsafe drinking water, poor sanitation, and low education status of parents. Therefore, vaccination may be recommended as optional vaccine at one year of age, along with improved public health efforts for safe drinking water, hygiene practices, and food safety.
Immunogenicity and Tolerability of Hepatitis A Vaccine in HIV-Infected Children
Clinical Infectious Diseases, 2005
The immunogenicity and tolerability of hepatitis A virus vaccine was evaluated in a group of 32 children with human immunodeficiency virus (HIV) infection and 27 children with seroreversion. After 2 doses of vaccine, 100% of children experienced seroconversion with good toleration of the vaccine. There were no differences in variation of virus load between immunized HIV-positive children and a group of 31 nonimmunized HIV-positive children with similar characteristics. The use of HAART has altered the natural history of AIDS, increasing the survival and the quality of life of HIV-infected patients [1, 2]. In parallel, one can observe the emergence of liver disease as one of the major causes of death in HIV-infected patients [3, 4]. Today, many HIV-infected patients have biochemical evidence of liver disease [3], sometimes with a fatal outcome [5]. The full extent and causes of liver disease in children with AIDS are unknown, but such causes include injury from drug therapy and nonspecific abnormalities that occur in patients with chronic illness, neoplasm, and opportunistic infection [4, 5]. In 1998, a seroepidemiologic study estimated the prevalence of hepatitis A virus (HAV) infection as 66.6% in the general population in the city of São Paulo, Brazil, with prevalences of 12.1% in those aged 2-4 years, 28.1% in those aged 5-7 years, and 35.8% in those aged 10-14 years [6]. Although hepatitis A vaccine is recommended for children living in regions with elevated rates of hepatitis A [7], no data
Clinician\'s Perspective on the Use of Hepatitis A Vaccine in Indian Children
Pediatric Infectious Disease
Hepatitis A, a waterborne endemic disease, is an important cause of acute viral liver disease in Indian children. Although self-limiting in most cases, hepatitis A can rarely cause life-threatening acute hepatic failure. It is the most common attributable cause for acute liver failure in children in countries of high endemicity. Changing epidemiology of hepatitis A in India has resulted in the coexistence of heterogeneous pockets of exposed and unexposed individuals in different social classes and regions. Epidemiological transition has also resulted in higher risk of hepatitis A infection and complications in older children and adults. Vaccines are the time tested and effective measures for prevention of hepatitis A infection; however, despite available vaccines, hepatitis A remains an important public health problem in India because of low vaccination coverage. Currently, two types of vaccines are available for prevention of hepatitis A: live attenuated vaccine and killed/inactivated vaccines. Live vaccine provides robust and long-term immunogenicity due to both humoral and cellular responses, unlike mostly humoral response with killed vaccines. Differences also exist in the schedule and route of administration of these vaccines. Live attenuated vaccine is administered subcutaneously and offers several advantages over killed vaccine including convenience, potential for better compliance, less cost due to singledose administration and less pain. In patients with bleeding disorder, subcutaneous administration can result in less chances of bleeding when compared with intramuscular administration. Moreover, published long-term immunogenicity data in Indian subjects are available only with live vaccine. In this article, we discuss the clinician's perspective on the use of hepatitis A vaccine in Indian children.
Immunization Against Hepatitis A in Migrant Children
The Pediatric Infectious Disease Journal, 2020
Background: Hepatitis A is endemic in many countries. Swiss guidelines recommend vaccinating patients native from endemic areas. In Geneva's Children's hospital, migrant children are screened and vaccinated if seronegative. Because hepatitis A's prevalence is decreasing worldwide, more children are seronegative at arrival, highlighting the need for immunization in medical centers and refugee camps and questioning the benefits of systematic serology. Other Swiss hospitals vaccinate regardless of serostatus. This study's aim is to assess migrant children's immunity according to origin and age, and the cost-effectiveness of different immunization strategies. Methods: We retrospectively analyzed 329 children's serostatus (1-16 years of age) between 2012 and 2015, using enzyme-linked fluorescent assay method. Serology and vaccine costs were based on local prices. Groups were compared with χ 2 test and the age-seropositivity relationship was studied with linear regression. Results: The predominant regions were the Eastern Mediterranean and European Regions with mostly negative serologies (71% and 83%) and the African Region with mostly positive serologies (79%). Immunity varied depending on birth country. Regardless of region, seropositivity increased with age (P < 0.001). The most cost-effective vaccination strategy was an individualized approach based on age and origin, reducing costs by 2% compared with serology-guided immunization and by 17% compared with systematic vaccination. Conclusions: Many migrant children >5 years old are seronegative and at risk of clinical infection. They need to be immunized. New guidelines according to age and origin should be defined to reduce immunization costs. We recommend systematic vaccination for patients <5 years old or native from low endemicity areas (≤25.7% of seropositivity). For the others, we propose serology-based vaccination.
An open non comparative study of a live attenuated H2 strain Hepatitis A vaccine of Chinese origin was carried out in 143 healthy Indian children aged 1 to 12 years (mean age 4.87 + 2.76 years; 88 boys, 55 girls). At baseline, all were negative for IgG HAV antibodies and had normal hematological and biochemical indices. Two months after a single dose of the vaccine (given subcutaneously), 137 children (i.e. 95.8%) developed protective antibodies of IgG >20 mIU / mL. The hematological and biochemical parameters remained within normal limits. There were no adverse events in any except mild fever in one child. In conclusion, live attenuated H2 strain Hepatitis A vaccine in a single dose was found to be immunogenic and safe in Indian children.